Mind the Gap: Building a bridge over the void of evidence on female performance

I recently attended a fabulous talk by Caroline Criado Perez, author of Invisible Women.  Caroline is a inspirational campaigner for women’s rights and equality, from getting Jane Austen on the £10 bank note to exposing data bias which puts women’s health and safety at risk. She didn’t disappoint during her talk, from her story of being an anti-feminist growing up to the lightbulb moments during her university education where she realised the world was based on the default male. What I love about Caroline is her diligence in researching the gap in data which systematically ignores half of the population in how the world is designed. She provides all the evidence we need to start making a difference. This is not speculation or assumption, this is real data, showing the bias that excludes women, and it is powerful stuff – her book is a must read for everyone!

On the same day, the gender gap in my own world of sports science was covered really nicely by Brittany Mitchell of ESPN with contribution from Dr Clare Minihan of Griffiths University in this article.  The piece alludes to the lack of research on female athlete health and performance compared to what we know and understand about male athletic performance.  Mitchell writes about how a gap between what we need to know and what we currently know creates an inclination for that space to be filled with speculation or assumption:

"There's lots of different views that have certainly come out in the media recently and not all of them are accurate," Minahan told ESPN. "Not all of them are based on science and I think that's where we take a step backwards when we're trying to move forwards in terms of female athletic performance, health and injury. We tend to want a quick fix and unfortunately all these things, all these answers to our questions aren't quick. We need to look at the science and we need to look at the research."

I have been reflecting, with similar thoughts, about my own journey in female athlete health and performance over the past few years.   I have been privileged to deliver lots of education, designed to empower women and those who work with them, with the knowledge of female physiology, and psychology and how that might influence an athlete’s health, training or performance.  This has coincided in the UK with a real energy within the media to cover women’s sports, and a more open conversation in the media and on social media about things like periods and the menstrual cycle.  All of this is fantastically positive. But it also lends itself to setting up unrealistic expectations of what can follow.  With their newfound knowledge of the menstrual cycle and the effects that hormones can have on everything from digestion to emotion, suddenly a new world of opportunities seems to opens up to athletes and coaches.  The questions that follow are; How do these hormones affected key factors which determine success in my sport?  Are women stronger at a certain time of the cycle?  Is endurance performance better in the second half of the cycle?  Can we use timing of the menstrual cycle to prescribe training so that athletes gets fitter / stronger?  Unfortunately, the evidence we need to be able to answer these questions isn’t strong enough yet.  Research hasn’t been quick enough to keep up with the appetite and enthusiasm that we’ve created in sport for this topic. That’s a good thing, by the way, good research takes time, and good research on the menstrual cycle takes a longer still! There’s some great people working on it, but we need patience!

Take the question of deciding to do different training sessions based on where you are in your cycle.  Oestrogen is thought to have ‘anabolic’ effects, that is, it helps the body build muscle.   A good time, one might suspect, to embark upon some weight training, so that your body is better suited, physiologically speaking, to build up muscle. It’s an attractive theory, and one that could well pan out, but for the moment we simply don’t know.  There are few papers researching this concept at all, but for every study (with small numbers of women) that says doing strength training more in the phase of your cycle where oestrogen is high will give you better strength gains there is a study to say that training in that way has absolutely no effect on your strength over training in a way not synched to menstrual cycle.  Just because we have evidence that oestrogen influences growth hormone, or that it effects metabolism, that does not mean that we can predict an improvement in sporting performance or adaptation to training with as much clarity. 

By emphasising the importance of the menstrual cycle and its influence on women in elite sport, are we setting up unrealistic expectations about what we can do with that information?  The Gartner hype cycle (shown below) tracks the trajectory of the common hypes, hopes and disappointments of promising innovation. It was introduced to me when reading ‘The Gendered Brain’ by Gina Rippon.  Often used in the technology industry it begins with an enthusiastic launch of a new technology, the accompanying media interest and hype which leads to a peak of inflated expectations –speculation about the problems that this new technology can solve. I think we are following Gartner’s hype cycle almost to the letter in our female athlete journey!  The trigger wasn’t technology, it was awareness and education, but the appetite for more information and the expectations of what we can do with the information we have, have definitely reached a peak of inflated expectation recently!   So how do we avoid what’s next – the ‘trough of disillusionment’ - since we don’t have all the answers to the questions that are being posed in light of our new awareness and understanding of the menstrual cycle and sport? 

Here’s how I think we make it to the ‘slope of enlightenment’.  We rein in the excitement about what may be possible in the future and we focus our excitement on what could be achieved right now, with the knowledge and tools that we do have, because it’s huge! What if an athlete got to know their individual cycle so well, that they could really tune in to when it was giving them ‘super powers’? Masses of energy and zest for life in the second week of the cycle? What a confidence boost that those training sessions might be PBs or you might be able to fit in a few more reps or miles because you feel so great.  If you are someone who sleeps better in the second half of your cycle?  What a great time to get to bed an hour early because you know your body will help you get some great recovery time. But what if your big competitions don’t land on those days when you feel brilliant?  Here’s comes the enlightenment:  We need to ensure that our Olympic and Paralympic athletes can be the medal winning version of themselves on any given day of their cycle.  That’s it.  That’s big. I haven’t met an athlete or coach yet who would say she’s confident that on any day of her cycle she won’t experience symptoms that means she could be her absolute best.  So what are we waiting for? Athletes and coaches need to work together, to get the best out of the best days of the cycle, and to diligently work to find strategies which alleviate negative symptoms of the cycle.  We know that women don’t push hard enough for remedies and solutions to things like PMS or period pain, but we can do lots with diet, natural supplements, yoga, heat and lifestyle management for cycle symptoms.  There’s so much we can be doing now to make sure the impact of the fabulous research that’s coming is realised.  Whilst we need to ‘mind the gap’ we don’t need to take a leap of faith over the other side and do things we don’t know are meaningful or beneficial.  We need to build a bridge. That bridge is creating the awareness, the engagement, the knowledge and tools to make it to the Plateau of productivity!   I think its an exciting time to be building that bridge to the future of female athlete performance and our ability to support women to realise their full performance potential.